Physician Brendan Bryne was working his shift at his New Westminster medical clinic when an elderly woman arrived for her first visit after being discharged from the hospital.

The only information Bryne had was a discharge document from the hospital with a crucial line, scribbled in illegible handwriting, giving the dosage for a potent drug prescribed for the patient.

While jokes have abounded for years about doctors’ messy handwriting, this was no laughing matter.

“Right beside the potassium there was a delta symbol to change from one potassium a day to two twice a day — I couldn’t tell if it was the potassium or the medication above that ... an overdose of potassium can kill somebody,” he said.

“Fortunately we were able to figure out what to do, but it was a bit unnerving to see that.”

For Byrne, the experience only served to reinforce the importance of the current shift to ehealth. Outmoded health delivery records are being replaced by digital technology that’s improving patient care and transforming our health care system.

“I once had a doc, an older fellow I was talking to about adopting EMR (electronic medical records),” said Bryne, who is also vice-president Physician Solutions for Telus Health (part of the Canadian telecom company Telus). “I picked up a chart and I said ‘would you take your car to a mechanic who kept records like this?’

“He looked at me and said, ‘no.’”

Bryne is among the players on the front line of the digital transformation in health care. He started Wolf Medical Systems, a company that grew to become the largest electronic medical records provider in Canada before it was acquired by Telus earlier this year.

Dr. Kendall Ho is an emergency medicine specialist and founding director of the Faculty of Medicine’s eHealth Strategy Office at the University of B.C.

Ho points to three major trends in the future of ehealth.

The first trend, he said, is in the use of mobile technology in health care.

Ho uses the example of banking, where once we could go to the bank for service, now banks go virtually to their customers using the Internet.

“How do we start moving from the historical context of let’s go see a doctor, a nurse, or go to a hospital to how do I leverage technology to bring this expertise around me,” said Ho. “It’s going to be a fundamental shift and the technology is helping us do that.”

On example is remote monitoring of patients. In a project in France, Telus Health is working with the wireless carrier Orange in a pilot project to monitor patients with kidney disease. Patients taking part in the trial were given a tablet computer along with software to monitor their vital signs and manage their medication. The patients connect online to their health care team to provide the data on the state of their health

The second trend has roots in the web and social media. While Ho said he encourages the trend in which patients check up to five sources of information — from their neighbour to Google — before they arrive in their doctor’s office, it’s not a case that we’ll start crowd-sourcing treatments on Twitter.

However, the web and social media can be used to harness collective knowledge, both of health professionals and of patients.

“I’m not suggesting that individual patients crowdsource their treatment — health professionals are trained — but that health professionals crowd-sourcing together can lead to new treatments,” said Ho.

“And patients crowd-sourcing with professionals can do research together. Those are the opportunities for us. Rather than a profession taking on the mandate, the vision, the duty to discover, I think on a system basis, how do we co-create.”

Wolters Kluwer Health, which provides information and business intelligence to the health care industry, conducted a survey in which it found 3 in 10 Americans say they turn to the Internet for answers to their medical questions, using search engines such as Google and Yahoo. Almost 50 per cent said they go online to check for medical information before visiting their doctor. Among physicians surveyed in an earlier study by Wolters Kluwer, 46 per cent says they turn to the Internet for answers.

In another example, Google Flu Trends was set up during the H1N1 pandemic to spot flu outbreaks by analyzing the location of clusters of search queries for influenza information.

A third trend that ehealth can support and enable is the understanding of global health populations, said Ho.

Ho uses the example of cancer genes that in some individuals can lead to cancer, but in others never causes breast cancer.

In general, health professionals don’t use social media but Ho sees that changing.

“Five, 10 years down the road I think there is no question health services will be delivered, will be exchanged on social media. … The question is how do we go from here to there and how do we engage health professionals to get there.”

Ho see social media as having the potential to help patients get correct information and counter messages that might be harmful.

“Health professionals have to understand not only that we shouldn’t stay away from the web, from social media, but we should actively participate, “ said Ho. “How do we drive the dynamics of social media and have an influence there to help our patients get the right information?”

Ehealth technologies — telehealth, electronic health records, and social media — have to be embedded as part of the work flow of the health system and for that, there needs to be policy innovation at different health of health administration and government to guide that process, said Ho.

Bryne sees the issues in ehealth both from the technology side and from his own practice. He still works one half-day a week in the clinic with the rest of his time spent advancing the ehealth transformation through his work with Telus, which has become Canada’s largest ehealth company.

While the company may be most familiar to consumers as a provider of telephone, Internet and television services, its ehealth division has 1,000 employees, including health care professionals working on a digital transformation that can range from electronic medical records to telehealth.

“Doctors who are graduating now are digital natives,” said Byrne. “They have no idea what to do with paper frankly.

“We’ve seen some older practices where docs in their 60s have adopted EMR (electronic medical records) purely on the basis that in order to pass their practice on they need to have adopted EMR — nobody is going to take a paper practice any more.”

François Côté, executive vice-president and president of both Telus Québec and Telus Health Solutions, has seen that firsthand in his own family.

“My daughter-in-law just graduated (from medical school),” he said. “She demanded to have EMR where she is going to work. … Doctors now are going to make it a condition of employment. She’s not going to work in a paper-based practice.”

Along with the expectation of upcoming generations of health care practitioners, ehealth is also gaining traction in public policy initiatives. Governments are driven to it by a need to make health care systems more efficient and effective.

“I think we have an incredible system that has been underinvested in IT,” said Côté. “If you look at the level of investment banks have done historically, telecom companies have done historically — a bunch of industries — health IT was not part of the investment.

“It is getting better but it is still underinvested.”

Côté however is optimistic that’s changing.

“Now I am carrying a message of hope,” he said. “We’re seeing things happen, we’re seeing a change, we are seeing people demanding better service, we are seeing governments saying yes, they’re starting to believe in that — they’re seeing a return on investment that is demonstrable.”

The return on investment can be measured not only in dollars and cents but in patients’ health. In some cases — such as avoiding wrongly administered drugs, it can mean the difference between life and death.

In one project in Montreal, remote patient monitoring has reduced visits to the emergency and re-admissions to hospital after patients are discharged by more than 50 per cent.

A recent study commissioned by Canada Health Infoway found that primary care practices with electronic medical records identified patients needing preventive or followup care 30 times more quickly than paper-based clinics. It took practices using EMRs on average 1.4 hours to review records of all their average patients, compared to the 40 hours that paper-based practices would need to conduct the same review of patient records.

In the end, it may be health care consumers who force digital transformation, a transformation that will ultimately see all systems interacting — from your doctor’s office, to the hospital, to pharmacists to your home computer or smartphone that will prompt you to take some responsibility for your own health — whether it’s showing up for lab tests or remembering to take your blood pressure medicine.

Decoding physician's handwriting can mean life or death

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